Anand Rathi Share & Stock Brokers Ltd.

Reg. Office Express Zone, A Wing, 10th Floor, WesternExpress Highway, Goregaon (East),
Mumbai – 400063 Maharashtra
Processing Office: Plot no CYB-2, Cyber Park, Heavy Industrial Area, Near Jodhpur
Dairy, Jodhpur 342003 ,Tel No 0291-7105560 E-mail: dp@rathi.com DP ID- 12010600
CIN : U67120MH1991PLC064106

TRANSMISSION REQUEST FORM

(In case of death of the sole holder)
Application No. Date D D M M Y Y Y Y
(Please fill all the details in Block Letters in English)
Dear Sir / Madam,

PART – I : (where nomination is recorded)

I/we, Nominee(s) / Successor/ Guardian of the successor or nominee(s) (in case of Minor) request you to transmit the following securities
due to the death of the sole account holder. Original Death Certificate / copy of Death Certificate (duly notarized / attested under seal by a
Gazetted Officer) is attached herewith.

Name of the deceased BO:

Account Number of the deceased BO:

DP ID Client ID

Kindly transmit all securities in the deceased BO’s account mentioned above to the BO account mentioned below. Details of
the Successor (s)

Sr. No Name of the Successor (s) DP ID Client ID

Details of Transmission

S.No. Name of the Security ISIN Quantity of Securities to be

transmitted

Attach an annexure duly signed by the Nominee(s)/ Successor / Guardian of the successor or nominee(s) (in case of
Minor), if the space above is insufficient.

(Nominees / Successor / Guardian of successor or nominee(s) (in case of Minor)

First / Sole Holder Second Holder Third Holder

Name

Signature

=============================(Please tear here)========================

Acknowledgement Receipt

Application No. Date: -

We hereby acknowledge receipt of the instructions for transmission of securities from the deceased BO’s account to the account
of the Nominee(s) / Successor / Guardian of the successor or nominee(s) (in case of Minor), as per details given on the transmission form.
Account number of the deceased BO
DP ID Client ID

Successor BO Name(s)
First/Sole Holder Second Holder Third Holder

Documents Submitted

Subject to verification. Depository Participants Seal & Signature

 Anand Rathi Share & Stock Brokers Ltd.
Reg. Office Express Zone, A Wing, 10th Floor, WesternExpress Highway, Goregaon (East),
Mumbai – 400063 Maharashtra
Processing Office: Plot no CYB-2, Cyber Park, Heavy Industrial Area, Near Jodhpur
Dairy, Jodhpur 342003 ,Tel No 0291-7105560 E-mail: dp@rathi.com DP ID- 12010600
CIN : U67120MH1991PLC064106

TRANSMISSION REQUEST FORM

(In case of death of one / more of the joint holders)

Application No. Date D D M M Y Y Y Y (Please

fill all the details in Block Letters in English)

Dear Sir / Madam,

I / We, the joint holder(s) / Successors request you to transmit the securities balance from: DP ID

Client ID

To

DP ID Client ID

Due to the death of ---------------------------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------(Name of the deceased account holder(s)).
Original Death Certificate / copy of Death Certificate (duly notarized / attested under seal by a Gazetted Off icer) is
attached herewith.

First / Sole Holder Second Holder

Name(s) of the surviving holder(s)

Signature(s) of the surviving holder(s

==========================(Please tear here)===========================

Acknowledgement Receipt
Application No. Date: -

We hereby acknowledge the receipt of the following instructions for transmission from: DP ID

Client ID

To

DP ID Client ID

Surviving Holder(s) Name(s)

First/Sole Holder Second Holder

Documents Submitted

Subject to verification.

Depository Participants Seal & Signature

 Anand Rathi Share & Stock Brokers Ltd.
Reg. Office Express Zone, A Wing, 10th Floor, WesternExpress Highway, Goregaon (East),
Mumbai – 400063 Maharashtra
Processing Office: Plot no CYB-2, Cyber Park, Heavy Industrial Area, Near Jodhpur
Dairy, Jodhpur 342003 ,Tel No 0291-7105560 E-mail: dp@rathi.com DP ID- 12010600
CIN : U67120MH1991PLC064106
Account Closure Request Form
Application No. Date D D M M Y Y Y Y
Closure Initiated by BO DP CDSL

(To be filled by the BO (in case of BO-initiated closure). Please fill all the details in Block Letters in English)

Dear Sir / Madam,

I / We the Sole Holder / Joint Holders / Guardian (in case of Minor) / Clearing Member request you to close my / our account with
you from the date of this application. The details of my/our account are given below:
Account Holder’s Details
DP ID Client ID Name of
the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Address for Correspondence

City State PIN

Details of remaining security balances in the account (if any)

Reasons for Closing the Account
Balance remaining in the account (if any) to be :
partly rematerialised and partly transferred. Rematerialised
Transferred to another account (Number given below) Not applicable
DP ID Client ID
Balance present in account for Ear - marked Pledged
(To be filled by DP, if applicable) Pending for Dematerialisation Frozen
Pending for Rematerialisation Lock-in

DECLARATION: In case of Account Closure due to SHIFTING OF ACCOUNT:

I/We declare and confirm that all the transactions in my/our demat account are true/ authentic.

First / Sole Holder Second Holder Third Holder

Name

Signature *

*If DP or CDSL initiates account closure, Signature(s) of account holder(s) not required.
===============================(Please Tear Hear)==============================
Acknowledgement Receipt
Application No. Date :-

We hereby acknowledge the receipt of the your instruction for Closing the following Account subject to verification: -
DP ID Client ID
Name of the First / Sole Holder
Name of the Second Holder
Name of the Third Holder
Reason for Closure

Depository Participant Seal and Signature

Instructions to Account Holder(s)
o Submit a duly-filled RRF if the balances are to be rematerialized.
o Submit a duly-filled Delivery Instruction Slip [DIS] (off market instruction slip) if the balances are to be
transferred to another Account. This requirement is not applicable in the case of “SHIFTING OF ACCOUN